scholarly journals Impact of Early Corticosteroids on 60-day Mortality in Critically Ill Patients with COVID-19: A Multicenter Cohort Study of the OUTCOMEREA Network

2021 ◽  
Author(s):  
Claire Dupuis ◽  
Etienne de Montmollin ◽  
Niccolò Buetti ◽  
Dany Goldgran-Toledano ◽  
Jean Reignier ◽  
...  
Keyword(s):  
Invasive Mechanical Ventilation ◽  
Bloodstream Infections ◽  
Survival Models ◽  
Multicenter Cohort Study ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Increased Risk ◽  
Study Population ◽  
High Doses ◽  
Hospital Acquired

Abstract ObjectivesIn severe COVID-19 pneumonia, the appropriate timing and dosing of corticosteroids(CS) is not known. Patient subgroups for which CS could be more beneficial also need appraisal. The aim of this study was to assess the effect of early CS in COVID-19 pneumonia patients admitted to the ICU on the occurrence of 60-day mortality, ICU-acquired-bloodstream infections(ICU-BSI), and hospital-acquired pneumonia and ventilator-associated pneumonia(HAP-VAP).MethodsWe included patients with COVID-19 pneumonia admitted to 11 ICUs belonging to the French OutcomeReaTM network from January to May 2020. We used survival models with ponderation with inverse probability of treatment weighting (IPTW). Inflammation was defined as Ferritin >1000 µg/l or D-Dimers >1000 µg/l or C-Reactive Protein >100 mg/dL.ResultsThe study population comprised 302 patients having a median age of 61.6(53-70) years of whom 78.8% were male and 58.6% had at least one comorbidity. The median SAPS II was 33(25-44). Invasive mechanical ventilation was required in 34.8% of the patients. Sixty-six (21.8%) patients were in the Early-CS-subgroup. Most of them (n=55, 83.3%) received high doses of steroids. Overall, 60-day mortality was 29.4%. The risks of 60-day mortality (IPTWHR =0.88;95% CI 0.55 to 1.39, p=0.58), ICU-BSI and HAP-VAP were similar in the two groups. Importantly, early CS treatment was associated with a lower mortality rate in patients aged 60 years or more (IPTWHR, 0.51;95% CI, 0.29 – 0.91; p=0.02). But, CS was associated with an increased risk of death for the patients younger than 60 years without inflammation on admission (IPTWHR =8.17;95% CI, 1.76, 37.85; p=0.01).ConclusionFor patients with COVID-19 pneumonia, early CS treatment was not associated with patient survival. Interestingly, inflammation and age can significantly influence the effect of CS.

scholarly journals Impact of early corticosteroids on 60-day mortality in critically ill patients with COVID-19: A multicenter cohort study of the OUTCOMEREA network

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255644
Author(s):  
Claire Dupuis ◽  
Etienne de Montmollin ◽  
Niccolò Buetti ◽  
Dany Goldgran-Toledano ◽  
Jean Reignier ◽  
...  
Keyword(s):  
Invasive Mechanical Ventilation ◽  
Bloodstream Infections ◽  
Survival Models ◽  
Multicenter Cohort Study ◽  
Risk Of Death ◽  
Increased Risk ◽  
Study Population ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Patient Subgroups

Objectives In severe COVID-19 pneumonia, the appropriate timing and dosing of corticosteroids (CS) is not known. Patient subgroups for which CS could be more beneficial also need appraisal. The aim of this study was to assess the effect of early CS in COVID-19 pneumonia patients admitted to the ICU on the occurrence of 60-day mortality, ICU-acquired-bloodstream infections(ICU-BSI), and hospital-acquired pneumonia and ventilator-associated pneumonia(HAP-VAP). Methods We included patients with COVID-19 pneumonia admitted to 11 ICUs belonging to the French OutcomeReaTM network from January to May 2020. We used survival models with ponderation with inverse probability of treatment weighting (IPTW). Results The study population comprised 303 patients having a median age of 61.6 (53–70) years of whom 78.8% were male and 58.6% had at least one comorbidity. The median SAPS II was 33 (25–44). Invasive mechanical ventilation was required in 34.8% of the patients. Sixty-six (21.8%) patients were in the Early-C subgroup. Overall, 60-day mortality was 29.4%. The risks of 60-day mortality (IPTWHR = 0.86;95% CI 0.54 to 1.35, p = 0.51), ICU-BSI and HAP-VAP were similar in the two groups. Importantly, early CS treatment was associated with a lower mortality rate in patients aged 60 years or more (IPTWHR, 0.53;95% CI, 0.3–0.93; p = 0.03). In contrast, CS was associated with an increased risk of death in patients younger than 60 years without inflammation on admission (IPTWHR = 5.01;95% CI, 1.05, 23.88; p = 0.04). Conclusion For patients with COVID-19 pneumonia, early CS treatment was not associated with patient survival. Interestingly, inflammation and age can significantly influence the effect of CS.

The prognostic efficacy of beta2-microglobulin in acute pulmonary embolism

2017 ◽  
Vol 16 (2) ◽  
pp. 52-59
Author(s):  
Sotirios Kakavas ◽  
◽  
Aggeliki Papanikolaou ◽  
Evangelos Balis ◽  
Evgenios Metaxas ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Increased Risk ◽  
Preliminary Study ◽  
Wbc Count ◽  
A Prospective Study ◽  
Acute Pe

Our aim was to prospectively assess the prognostic value of beta2- microglobulin (b2-M) in patients with acute pulmonary embolism (PE). We conducted a prospective study of 109 patients admitted in a pulmonary clinic due to acute PE. A panel of inflammatory markers including b2-M white blood cell (WBC) count and C-reactive protein (CRP) was determined for each patient. In this preliminary study, baseline b2-M levels significantly correlated with the impairment of oxygenation and with all the parameters that are used for the early risk stratification of patients. In multivariate analysis, patients’ age and baseline b2-M levels were significantly associated with an increased risk of death. These findings require further prospective validation.

Hemodialysis Patients with Pruritus and Insomnia Have Increased Risk of Death

2020 ◽  
Vol 49 (4) ◽  
pp. 419-425
Author(s):  
Olga Hilda Orasan ◽  
Flaviu Muresan ◽  
Augustin Mot ◽  
Adela Sitar Taut ◽  
Iulia Minciuna ◽  
...  
Keyword(s):  
Study Groups ◽  
Poor Quality ◽  
Exclusion Criteria ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Survival Difference ◽  
Increased Risk ◽  
Laboratory Features ◽  
Impact On Survival

Background: Pruritus and insomnia are common disorders in hemodialysis (HD) patients, with a major clinical impact as they are associated with poor quality of life and increased mortality. Their coexistence and impact on survival in HD patients have rarely been investigated. Our aim is to investigate the survival of HD patients presenting either none, one, or both disorders and to compare certain features between these groups. Methods: After the inclusion/exclusion criteria, 170 patients treated by HD or online hemodiafiltration were assigned in 4 study groups depending on the presence of either, neither, or both pruritus and insomnia. We analyzed the survival difference between groups after 20 months, and we searched if there were significant differences in terms of clinical and laboratory features. Results: Survival at 20 months was lower in patients with both pruritus and insomnia. Patients with pruritus alone had a lower Kt/V than those with no complaints or insomnia alone. Those with no complaints had lower C-reactive protein and higher albumin levels than patients with insomnia alone or both conditions. Conclusion: Pruritus and insomnia should be actively investigated and correlated with some clinical and laboratory features as they have a significant impact on survival in HD patients.

scholarly journals Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

2020 ◽  
Vol 45 (6) ◽  
pp. 1018-1032
Author(s):  
Imran Chaudhri ◽  
Richard Moffitt ◽  
Erin Taub ◽  
Raji R. Annadi ◽  
Minh Hoai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Invasive Mechanical Ventilation ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Hospital Death ◽  
Study Cohort ◽  
Icu Admission ◽  
Risk Of Death ◽  
Increased Risk

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. <b><i>Methods:</i></b> This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, <i>t</i> test, χ<sup>2</sup> test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. <b><i>Results:</i></b> Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, <i>p</i> = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). <b><i>Conclusion:</i></b> Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

Increased risk of death and readmission after hospital discharge of critically ill patients in a developing country: a retrospective multicenter cohort study

2018 ◽  
Vol 44 (7) ◽  
pp. 1090-1096 ◽  
Author(s):  
Vanessa Chaves Barreto Ferreira de Lima ◽  
Ana Luiza Bierrenbach ◽  
Gizelton Pereira Alencar ◽  
Ana Lucia Andrade ◽  
Luciano Cesar Pontes Azevedo
Keyword(s):  
Cohort Study ◽  
Developing Country ◽  
Hospital Discharge ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multicenter Cohort Study ◽  
Risk Of Death ◽  
Multicenter Cohort ◽  
Increased Risk

Predictors of survival with Alzheimer's disease: a community-based study

1995 ◽  
Vol 25 (1) ◽  
pp. 171-177 ◽  
Author(s):  
Carol Jagger ◽  
Michael Clarke ◽  
Andrew Stone
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Institutional Care ◽  
Community Based ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of ◽  
Group A ◽  
Study Population ◽  
Heavy Alcohol Use

SynopsisFactors associated with reduced survival were investigated in elderly people diagnosed as having Alzheimer's disease (AD) and in those free of dementia at diagnosis. The study population comprised 155 people free of dementia and 222 with AD; all were aged 75 years and over and were part of a two-stage prevalence study of dementia during 1988 in Melton Mowbray, Leicestershire. An increased risk of death was found for those with a history of heavy alcohol use, lower cognitive function, a history of heart failure and those in institutional care, these factors acting in the same manner for persons free of dementia and those with AD. For the non-demented group a greater risk of death was found with increasing age and for those with a history of cancer. A greater risk of death was found for males with AD compared to females with the risk increasing over time. The longer survival of women over men may explain the sex differences found in the prevalence of AD without accompanying differences in incidence.

Validation of risk assessment models predicting venous thromboembolism in inpatients with AECOPD: a multicenter cohort study

2021 ◽  
Author(s):  
Chen Zhou ◽  
Qun Yi ◽  
Huiqing Ge ◽  
Hailong Wei ◽  
Huiguo Liu ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Assessment Model ◽  
Risk Level ◽  
Chronic Obstructive ◽  
Multicenter Cohort Study ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Study Population

Background: As inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are at increased risk for venous thromboembolism (VTE), identifying high-risk patients requiring thromboprophylaxis is critical to reduce the mortality and morbidity associated with VTE. This study aimed to evaluate and compare the validities of the Padua Prediction Score and Caprini risk assessment model (RAM) in predicting the risk of VTE in inpatients with AECOPD. Methods: The inpatients with AECOPD were prospectively enrolled from seven medical centers of China between September 2017 and January 2020. Caprini and Padua scores were calculated on admission, and the incidence of 3-month VTE was investigated. Results: Among the 3277 eligible patients with AECOPD, 128 patients (3.9%) developed VTE within 3 months after admission. The distribution of the study population by the Caprini risk level was as follows: high, 53.6%; moderate, 43.0%; and low, 3.5%. The incidence of VTE increased by risk level as high, 6.1%; moderate, 1.5%; and low, 0%. According to the Padua RAM, only 10.9% of the study population was classified as high risk and 89.1% as low risk, with the corresponding incidence of VTE 7.9% and 3.4%, respectively. The Caprini RAM had higher area under curve (AUC) compared with the Padua RAM (0.713  0.021 vs 0.644 ± 0.023, P = 0.029). Conclusion: The Caprini RAM was superior to the Padua RAM in predicting the risk of VTE in inpatients with AECOPD and might better guide thromboprophylaxis in these patients.

scholarly journals Biomarkers Associated with Death After Initiating Treatment for Tuberculosis and HIV in Patients with Very Low CD4 Cells

2018 ◽  
Vol 3 (1) ◽  
pp. 46 ◽  
Author(s):  
Fred Richard Sattler ◽  
Daniel Chelliah ◽  
Xingye Wu ◽  
Alejandro Sanchez ◽  
Michelle A. Kendall ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
C Reactive Protein ◽  
Retrospective Case ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Treatment Naïve ◽  
Low Bmi

Background: The risk of short-term death for treatment naive patients dually infected with Mycobacterium tuberculosis and HIV may be reduced by early anti-retroviral therapy. Of those dying, mechanisms responsible for fatal outcomes are unclear. We hypothesized that greater malnutrition and/or inflammation when initiating treatment are associated with an increased risk for death.Methods: We utilized a retrospective case-cohort design among participants of the ACTG A5221 study who had baseline CD4 < 50 cells/mm3. The case-cohort sample consisted of 51 randomly selected participants, whose stored plasma was tested for C-reactive protein, cytokines, chemokines, and nutritional markers. Cox proportional hazards models were used to assess the association of nutritional, inflammatory, and immunomodulatory markers for survival.Results: The case-cohort sample was similar to the 282 participants within the parent cohort with CD4 < 50 cells/mm3. In the case cohort, 7 (14%) had BMI < 16.5 (kg/m2) and 17 (33%) had BMI 16.5-18.5(kg/m2). Risk of death was increased per 1 IQR width higher of log10 transformed level of C-reactive protein (adjusted hazard ratio (aHR) = 3.42 [95% CI = 1.33-8.80],P = 0.011), interferon gamma (aHR = 2.46 [CI = 1.02-5.90], P = 0.044), MCP-3 (3.67 [CI = 1.08-12.42], P = 0.037), and with IL-15 (aHR = 2.75 [CI = 1.08-6.98], P = 0.033) and IL-17 (aHR = 3.99 [CI = -1.06-15.07], P = 0.041). BMI, albumin, hemoglobin, and leptin levels were not associated with risk of death.Conclusions: Unlike patients only infected with M. tuberculosis for whom malnutrition and low BMI increase the risk of death, this relationship was not evident in our dually infected patients. Risk of death was associated with significant increases in markers of global inflammation along with soluble biomarkers of innate and adaptive immunity.

1350Outcome after diagnosis with hypertrophic cardiomyopathy: a nationwide study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Jacobsen ◽  
D Modin ◽  
L Koeber ◽  
E L Fosboel ◽  
A Axelsson
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Hazard Analysis ◽  
Treatment Strategies ◽  
Risk Of Death ◽  
Kaplan Meier ◽  
Background Population ◽  
Increased Risk ◽  
Study Population ◽  
Disease Modifying Treatment

Abstract Background Patients with hypertrophic cardiomyopathy (HCM) are generally considered to have an increased morbidity and mortality due to symptomatic heart failure, atrial fibrillation, stroke and sudden cardiac death. Data reporting the mortality compared with background populations are however conflicting and primarily based on small cohorts from tertiary centers. Purpose We aimed to investigate whether a nationwide cohort of patients with HCM had an increased risk of death compared with a matched cohort derived from the general Danish population. Methods Using nationwide registries, we identified all patients with a first-time HCM diagnosis in Denmark between 2007 and 2016. Patients were matched 1:5 on age, sex and HCM diagnosis date to controls using risk set sampling. The study population was followed until death, emigration, or end of study period Jan. 1, 2017–whichever came first. Mortality was compared using Kaplan Meier plots and multivariable adjusted Cox proportional hazard analysis. Results We identified 3010 patients diagnosed with HCM (53.8% male) per registry codes. Men were on average 8.5 years younger at diagnosis than women (62.6 years [p25-p75: 49.8–73.9] vs. 71.1 years [p25-p75: 59.7–80.6]). Patients with HCM had more comorbidities than matched controls. The median time of follow-up was 4.4 years (p25-p75: 2.3, 6.7). For HCM patients and matched controls, 1-year, 5-year and 10-year probabilities of death were 10% (95% CI 9–12%), 28% (95% CI 26–30%) and 47% (95% CI 42–51%) and 2% (95% CI 1–3%), 13% (95% CI 12–14%) and 24% (95% CI 23–25%) respectively (Figure 1). After adjusting for comorbidities and medications a diagnosis of HCM was associated to a 107% increased risk of death (hazard ratio 2.07 [95% confidence interval 1.60, 2.68], p<0.0001). Figure 1 Conclusion In a Danish nationwide cohort, HCM was associated with a significantly higher risk of death compared with the background population. This study emphasizes the importance of continued, life-long follow-up of patients with HCM with the aim to anticipate and treat preventable adverse events. Furthermore, the findings stress the need to develop effective disease-modifying treatment strategies.

scholarly journals Effect of health systems context on infant and child mortality in sub-Saharan Africa from 1995 to 2015, a longitudinal cohort analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryan A. Simmons ◽  
Rebecca Anthopolos ◽  
Wendy Prudhomme O’Meara
Keyword(s):  
Health Service ◽  
Cohort Analysis ◽  
Child Survival ◽  
Sub Saharan Africa ◽  
Survival Models ◽  
Poor Child ◽  
Risk Of Death ◽  
Increased Risk ◽  
Sub Saharan ◽  
The Impact

AbstractEach year, > 3 million children die in sub-Saharan Africa before their fifth birthday. Most deaths are preventable or avoidable through interventions delivered in the primary healthcare system. However, evidence regarding the impact of health system characteristics on child survival is sparse. We assembled a retrospective cohort of > 250,000 children in seven countries in sub-Saharan Africa. We described their health service context at the subnational level using standardized surveys and employed parametric survival models to estimate the effect of three major domains of health services—quality, access, and cost—on infant and child survival, after adjusting for child, maternal, and household characteristics. Between 1995 and 2015 we observed 13,629 deaths in infants and 5149 in children. In fully-adjusted models, the largest effect sizes were related to fees for services. Immunization fees were correlated with poor child survival (HR = 1.20, 95% CI 1.12–1.28) while delivery fees were correlated with poor infant survival (HR = 1.11, 95% CI 1.01–1.21). Accessibility of facilities and greater concentrations of private facilities were associated with improved infant and child survival. The proportion of facilities with a doctor was correlated with increased risk of death in children and infants. We quantify the impact of health service environment on survival up to five years of age. Reducing health care costs and improving the accessibility of health facilities should remain a priority for improving infant and child survival. In the absence of these fundamental investments, more specialized interventions may not achieve their desired impact.

Sign in / Sign up

Export Citation Format

Share Document